BMC Anesthesiology最新文献

{"title":"Putting the pieces together: Clinical judgment from the perspective of registered nurse anaesthetists and anaesthesiologists at tracheal extubations after general anaesthesia.","authors":"Linda Rönnberg, Emma Brulin, Bodil J Landstad, Christina Melin-Johansson, Ulrica Nilsson, Maria Härgestam","doi":"10.1186/s12871-026-04143-w","DOIUrl":"10.1186/s12871-026-04143-w","url":null,"abstract":"<p><strong>Background: </strong>Extubation of patients undergoing general anaesthesia is a shared concern among registered nurse anaesthetists and anaesthesiologists. Although it has been described as complex and unpredictable, knowledge of this critical moment remains limited. Clinical judgment is consistently applied when making crucial decisions regarding patient care. This study aimed to investigate how RNAs and ANs expressed clinical judgment during extubation through noticing, interpreting, responding, and reflecting.</p><p><strong>Methods: </strong>A qualitative reflexive thematic analysis was conducted, using interviews with registered nurse anaesthetists and anaesthesiologists from university and regional hospitals in Sweden. Triangulation was used to explore the perspectives of registered nurse anaesthetists (n = 20) and anaesthesiologists (n = 17) at extubations. Two datasets, one from focus group interviews with registered nurse anaesthetists and one from individual interviews with anaesthesiologists, were used to triangulate data.</p><p><strong>Results: </strong>Extubation was described as a dynamic process of clinical judgment, where anaesthesia professionals continuously integrated clinical cues, experience, and situational awareness to ensure patient safety. Multisensory patient-related and situational cues were attended to and integrated to form an initial understanding of the patient's condition. These cues were interpreted through prior experience and pattern recognition, while responses were shaped by context and often guided by embodied intuition. Reflection both in action and on action supported ongoing adjustment and the development of clinical judgment over time.</p><p><strong>Conclusions: </strong>During extubation, registered nurse anaesthetists and anaesthesiologists exercised clinical judgment by putting the pieces together, continuously integrating clinical cues, experience, and situational awareness. This process involved multisensory noticing, experience-based interpretation, context-dependent responding often guided by embodied intuition, and ongoing reflection to ensure patient safety. These findings highlight the importance of supporting clinical judgment through experience-based learning, reflective practice, and work environments that enable focused attention during extubation.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-operative prediction of difficult tracheal intubation using an explainable multi-pose shared encoder vision transformer: a prospective observational study.","authors":"Serkan Telli, Süleyman Camgöz, Naciye Nur Arslan, Durmuş Özdemir","doi":"10.1186/s12871-026-04156-5","DOIUrl":"10.1186/s12871-026-04156-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Difficult tracheal intubation remains poorly predicted by conventional bedside airway tests. Facial photographs analysed by deep learning have been proposed as an alternative, and multi-pose acquisition protocols are increasingly advocated; however, whether acquiring more poses actually improves prediction has not been tested.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this prospective, single-centre observational study, standardised pre-operative facial photographs were obtained in seven poses from 250 patients undergoing surgery under general anaesthesia with orotracheal intubation. Difficult intubation was defined pragmatically as two or more intubation attempts and/or use of an alternative airway device. A multi-pose shared-encoder Vision Transformer was trained and evaluated under stratified five-fold cross-validation for every one of the 127 possible pose combinations and compared with conventional bedside tests. To quantify post-selection optimism, the pose-selection step was itself nested within the resampling: it was repeated using the training folds only and evaluated in the withheld fold. The calibration of the preferred configuration was assessed under a separate held-out scheme.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Difficult intubation occurred in 70 of 250 patients (28.0%). Conventional bedside tests discriminated poorly: the highest area under the receiver operating characteristic curve (AUC) was 0.66 (95% CI 0.58 to 0.73) for a neck circumference ≥ 400 mm, and the confidence interval of every other test included 0.50. Across all 127 combinations, discrimination was unrelated to the number of poses acquired (Spearman's rho = 0.09, P = 0.34): the seven-pose model (mean AUC 0.666) performed no better than the average single-pose model (0.660). Inter-fold variability fell markedly once more than one pose was acquired (median SD of AUC 0.170 for single-pose versus 0.098 for multi-pose combinations; P &lt; 0.001) and did not fall further thereafter. After this pose-number analysis, upper lip bite plus lateral neutral position was selected as a pragmatic two-pose candidate on the basis of discrimination, stability, anatomical complementarity, and acquisition burden. It ranked first among the 21 two-pose combinations and tied third overall under the four-criterion ranking, achieving a mean AUC of 0.688 (95% CI 0.594 to 0.781), with pooled out-of-fold sensitivity 67.1% and specificity 71.1%; its confidence interval overlapped that of neck circumference.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Acquiring additional facial poses did not improve the prediction of difficult tracheal intubation. A second, anatomically complementary pose stabilised an otherwise erratic estimate, but further poses produced no observed gain in discrimination or stability. The internally cross-validated performance of the pragmatic two-pose candidate was modest and was not demonstrably superior to neck circumference. Nesting the pose-selection step withi","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of intravenously administered norepinephrine on early postoperative tissue perfusion of radial free forearm flaps in the head and neck region - retrospective analysis in the context of continuous flap monitoring.","authors":"Mark Ooms, Philipp Winnand, Marius Heitzer, Nils Vohl, Marie Sophie Katz, Johannes Bickenbach, Frank Hölzle, Ali Modabber","doi":"10.1186/s12871-026-04169-0","DOIUrl":"https://doi.org/10.1186/s12871-026-04169-0","url":null,"abstract":"<p><strong>Background: </strong>Postoperative flap monitoring following microvascular head and neck reconstruction can be conducted by continuous flap tissue perfusion measurement with an attached surface probe using the Oxygen-to-see (O2C) analysis system. However, intravenously administered norepinephrine may influence flap tissue perfusion and affect the reliability of predefined absolute thresholds used for the detection of vascular flap compromise. This study aimed to evaluate the association between early postoperative flap tissue perfusion and norepinephrine in radial free forearm flaps (RFFF).</p><p><strong>Methods: </strong>Data of patients undergoing head and neck reconstruction with an RFFF from 2020 until 2022 were retrospectively analyzed. Flap tissue perfusion was measured continuously for 8 h postoperatively with an attached surface probe using the O2C analysis system. Intravenously administered norepinephrine dose and blood flow and hemoglobin oxygen saturation as well as flow resistance (ratio of mean arterial blood pressure and flap blood flow) were analyzed for associations.</p><p><strong>Results: </strong>The study included 12 patients (5 men and 7 women). Blood flow and hemoglobin oxygen saturation were not associated with norepinephrine (B=-110.509, p = 0.583 and B=-12.500, p = 0.912). In addition, flow resistance was not associated with norepinephrine (B = 0.292, p = 0.825).</p><p><strong>Conclusions: </strong>Early postoperative tissue perfusion of RFFFs, measured during continuous flap monitoring with attached surface probes for the O2C analysis system, showed no association with norepinephrine with regard for blood flow and hemoglobin oxygen saturation. This supports the reliability of absolute thresholds used to detect vascular flap compromise during continuous postoperative monitoring of RFFFs with the O2C analysis system, albeit additional studies with substantial sample sizes and longer monitoring intervals are required to validate these findings.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13483590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of propofol and propofol-ketamine anesthesia on optic nerve sheath diameter in endovascular cerebral aneurysm procedures: a prospective randomized study.","authors":"Eda Şahin, Nihal Gökbulut Özaslan, Gokhan Erdem, Güven Özkaya","doi":"10.1186/s12871-026-04158-3","DOIUrl":"10.1186/s12871-026-04158-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Endovascular treatment of unruptured intracranial aneurysms requires anesthetic strategies that maintain cerebral perfusion and hemodynamic stability while avoiding increases in intracranial pressure (ICP). Optic nerve sheath diameter (ONSD) measured by ultrasonography is commonly used as a noninvasive surrogate marker of ICP. This study compared propofol and propofol-ketamine anesthesia with respect to perioperative ONSD, cerebral oxygenation, and hemodynamic parameters during endovascular aneurysm procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this prospective, randomized, single-center, observer-blinded trial, 40 adults undergoing elective endovascular treatment of unruptured intracranial aneurysms were allocated to a propofol group (P, n = 20) or a propofol-ketamine group (KP, n = 20). Standardized anesthetic protocols and ventilation targeting normocapnia were used in both groups. ONSD, regional cerebral oxygen saturation (rSO₂), bispectral index (BIS), and hemodynamic variables were recorded at predefined perioperative time points. The primary outcome was the temporal change in mean ONSD. Mean ONSD was analyzed using a linear mixed-effects model including group, time, and group × time interaction. Secondary longitudinal outcomes were analyzed using exploratory mixed-effects models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Baseline demographic and clinical characteristics were comparable between groups. Total propofol consumption was significantly lower in the KP group, whereas remifentanil use showed a non-significant trend toward reduction. In the primary mixed-effects analysis, the group × time interaction for mean ONSD was not statistically significant, indicating that the temporal trajectory of ONSD did not differ between groups. The main effect of group was also not significant, whereas the main effect of time was significant. Exploratory analyses of secondary longitudinal outcomes showed significant group × time interactions for selected hemodynamic, ventilation-related, anesthetic depth, and cerebral oxygenation parameters, including DBP, MAP, EtCO₂, BIS, and mean rSO₂. Heart rate and SpO₂ trajectories were comparable between groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this small randomized cohort of patients undergoing elective endovascular treatment of unruptured intracranial aneurysms, propofol and propofol-ketamine anesthesia showed comparable ONSD trajectories over time. The propofol-ketamine regimen was associated with reduced propofol consumption and exploratory evidence of differential perioperative hemodynamic and cerebral oxygenation profiles. However, the study was not powered to evaluate safety outcomes or rare adverse events. Larger neurosurgical trials are required before firm conclusions regarding safety and clinical feasibility can be drawn.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;The study was registered at ClinicalTrials.gov (identifier NCT07542015) on April 14, 2026. Retrospectively reg","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative pulmonary complications after high-altitude thoracic surgery requiring one-lung ventilation: a single-centre retrospective cohort study.","authors":"Yanqing Luo, Ronghui Li, Laba Ciren, Xingyue Su, Haiyang Ding, Qi Yan","doi":"10.1186/s12871-026-04139-6","DOIUrl":"https://doi.org/10.1186/s12871-026-04139-6","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pulmonary complications (PPCs) are common adverse outcomes after thoracic surgery and one-lung ventilation (OLV). Their reported incidence varies with endpoint definition and ascertainment. Lower inspired oxygen partial pressure may alter perioperative oxygenation at high altitude, but direct evidence from thoracic OLV cohorts remains limited. We described PPC occurrence and evaluated associated patient and perioperative factors in a high-altitude thoracic OLV cohort.</p><p><strong>Methods: </strong>This single-centre retrospective cohort included adults undergoing thoracic surgery with general anaesthesia and OLV at Tibet Autonomous Region People's Hospital (Lhasa, approximately 3,650 m). The primary outcome was an in-hospital composite outcome comprising postoperative pneumonia, imaging-confirmed atelectasis, acute respiratory distress syndrome (ARDS), postoperative respiratory failure, initial postoperative ventilatory support lasting more than 48 h, or reintubation, with events assessed within the first 7 postoperative days. The primary multivariable logistic regression analysis used multiple imputation by chained equations and included 14 covariates. Complete-case and no-BMI multiple-imputation models were sensitivity analyses. Marginally standardised risk ratios (RRs) and average marginal effects (AMEs) complemented odds ratios (ORs).</p><p><strong>Results: </strong>Among 492 patients, 211 developed PPCs (42.9%), mainly atelectasis (141, 28.7%) and pneumonia (113, 23.0%). In the primary model, ASA physical status at least III (OR 2.37, 95% confidence interval [CI] 1.32-4.26; P = 0.004), preoperative anaemia (OR 2.74, 95% CI 1.56-4.81; P < 0.001), surgical duration per 1-hour increase (OR 1.40, 95% CI 1.17-1.68; P < 0.001), and bronchial blocker use (OR 2.81, 95% CI 1.33-5.90; P = 0.007) remained associated with PPCs after multivariable adjustment. Corresponding RRs for these four factors were 1.45, 1.52, 1.16, and 1.51, and AMEs were + 18.1, + 20.6, + 6.8, and + 21.0% points, respectively. The directions and statistical significance of these associations were consistent in sensitivity analyses.</p><p><strong>Conclusions: </strong>In this single-centre high-altitude thoracic OLV cohort, PPCs occurred in 42.9% of patients and were predominantly atelectasis and pneumonia. After multivariable adjustment, ASA physical status ≥ III, preoperative anaemia, longer surgical duration, and bronchial blocker use remained associated with PPCs. The bronchial-blocker estimate is susceptible to confounding by indication. Without a low-altitude comparator or granular ventilation data, the findings should be interpreted as observational, hypothesis-generating signals rather than causal effects of altitude or lung-isolation devices. External validation is required.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tigecycline pharmacokinetics in critically ill patients receiving extracorporeal membrane oxygenation: a prospective multicentre pilot study.","authors":"Rawan Alraish, Afrah Alkazemi, Kamal M Matar, Sara F Buabbas, Abdulaziz Al-Mutawa, Abdulrahman Al-Fares","doi":"10.1186/s12871-026-04114-1","DOIUrl":"10.1186/s12871-026-04114-1","url":null,"abstract":"<p><strong>Background: </strong>Tigecycline is frequently used to treat multidrug-resistant infections in critically ill patients. However, its pharmacokinetics in patients receiving extracorporeal membrane oxygenation (ECMO) are poorly defined, raising concerns about the adequacy of standard dosing in this population.</p><p><strong>Methods: </strong>This prospective, multicentre pilot study included adult ICU patients receiving venovenous (VV) or venoarterial (VA) ECMO and standard tigecycline dosing. Serial plasma samples were collected at steady state to determine tigecycline concentrations using liquid chromatography-tandem mass spectrometry. Pharmacokinetic parameters, including maximum plasma concentration (C_max), trough plasma concentration (C_min), area under the concentration-time curve (AUC), and systemic clearance (CL), were calculated. Microbiological samples were obtained before therapy initiation. Pharmacokinetic parameters were compared between ECMO configurations and correlations with organ function markers were assessed using Spearman analysis.</p><p><strong>Results: </strong>Fifteen patients were included (13 VV-ECMO, 2 VA-ECMO). Marked interindividual variability in tigecycline exposure was observed. Median C_max was 0.50 µg/mL, with consistently low trough concentrations. Plasma levels generally exceeded EUCAST MIC breakpoints for Gram-positive pathogens but were lower for Gram-negative organisms. Patients receiving VA-ECMO exhibited numerically higher tigecycline exposure than those on VV-ECMO. Moderate, non-significant positive correlations were observed between total bilirubin levels and tigecycline exposure.</p><p><strong>Conclusion: </strong>Tigecycline pharmacokinetics in ECMO-supported critically ill patients show high variability, with higher exposure in VA-ECMO than in VV-ECMO. Standard dosing may be insufficient, supporting therapeutic drug monitoring and further studies to inform individualized dosing strategies in this complex population.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and risk factors of persistent postoperative pain after cardiac surgery: a systematic review and meta-analysis.","authors":"Ye Yang, Feiyue Liu, Huiping Yao","doi":"10.1186/s12871-026-04089-z","DOIUrl":"10.1186/s12871-026-04089-z","url":null,"abstract":"<p><strong>Background: </strong>Persistent postoperative pain after cardiac surgery (PPPCS) is a prevalent complication. This paper aims to appraise the incidence of PPPCS and analyze its related risk factors through systematic evaluation and Meta-analysis.</p><p><strong>Methods: </strong>According to PRISMA guidelines, two researchers independently searched seven databases (PubMed, Cochrane Library, Web of Science, Scopus, China National Knowledge Infrastructure, Wanfang Database and China Biomedical Database) until October 5, 2024. Finally, 40 eligible studies were included. The quality of the included articles was evaluated by Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality Agency Scale. The random-effect model was selected for Meta-analysis. Meta-regression analysis was conducted to test whether the publication time affected the incidence of PPPCS.</p><p><strong>Results: </strong>The incidence of PPPCS changed at different times after operation: 31.7% (27.2%, 36.2%) at 3 to 6 months, 25.1% (19.5%, 30.7%) at 6 to 12 months, 24.4% (18.1%, 30.7%) at 12 to 24 months, and 13.1% (7.6%, 18.6%) at more than 24 months. Meta-regression revealed that longer postoperative follow-up (12-24 months and beyond 24 months) was associated with a lower overall incidence of PPPCS.Significant risk factors included females, age < 69 years old, BMI≥28 kg/m², poor wound healing, intraoperative remifentanil infusion, chronic pain history, and moderate-severe pain (day 0-5).</p><p><strong>Conclusion: </strong>The incidence of PPPCS ranged from 13.1% to 31.7%. Female sex, younger age, elevated BMI, poor wound healing, intraoperative remifentanil use, history of chronic pain, and severe acute postoperative pain were associated with higher odds of PPPCS. However, given the observational nature of the included studies, variable confounder adjustment, small numbers of studies for certain risk factors, and high heterogeneity, these associations should be interpreted cautiously and require confirmation in prospective studies with standardized definitions and more comprehensive adjustment. The identified factors may guide risk stratification but should not yet be regarded as definitively established causal determinants of PPPCS.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between pericapsular nerve group (PENG) block and postoperative inflammatory indices and analgesic outcomes in total hip arthroplasty: a randomized controlled trial.","authors":"Anna Perek, Serkan Tulgar, Tomasz Reysner, Katrzyna Wieczorowska-Tobis, Paweł Pietraszek, Justyna Marszałek-Buko, Malgorzata Reysner","doi":"10.1186/s12871-026-04084-4","DOIUrl":"10.1186/s12871-026-04084-4","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) induces a pronounced postoperative inflammatory response that contributes to pain, increased opioid requirements, and delayed recovery, particularly in older adults. Although the pericapsular nerve group (PENG) block provides effective analgesia, its impact on systemic inflammation remains insufficiently defined.</p><p><strong>Methods: </strong>In this prospective, randomized, quadruple-blinded controlled trial, patients aged ≥ 60 years undergoing elective unilateral THA performed under spinal anesthesia were randomized (1:1) to receive an ultrasound-guided PENG block with ropivacaine or a sham block. The primary outcome was the neutrophil-to-lymphocyte ratio (NLR) at 12 h postoperatively. Secondary outcomes included platelet-to-lymphocyte ratio (PLR) at 12, 24, and 48 h, postoperative pain scores, time to first opioid administration, and cumulative opioid consumption within 48 h.</p><p><strong>Results: </strong>Sixty patients completed the study (30 per group). Baseline inflammatory markers were comparable between groups. At 12 h, NLR was significantly lower in the PENG group than in the control group (5.98 ± 1.42 vs. 9.60 ± 1.83; adjusted p < 0.0001), with sustained reductions at 24 h (2.47 ± 0.77 vs. 5.71 ± 1.74; adjusted p < 0.0001) and 48 h (1.84 ± 0.71 vs. 3.53 ± 1.08; adjusted p < 0.0001). PLR was also significantly lower in the PENG group at all postoperative time points (all adjusted p < 0.0001), with a significantly different postoperative trajectory between groups over time. The PENG block significantly prolonged time to first opioid administration (15.0 ± 1.5 vs. 9.3 ± 1.7 h; p < 0.001) and reduced cumulative 48-h opioid consumption (13.2 ± 2.7 vs. 20.8 ± 3.2 mg; p < 0.001). Pain scores at rest and during mobilization were consistently lower in the PENG group throughout the first 24 h.</p><p><strong>Conclusions: </strong>In older adults undergoing THA, the PENG block was associated with lower postoperative inflammatory indices, improved pain control, and reduced opioid requirements. Because NLR and PLR are indirect inflammatory markers, these findings should be interpreted cautiously and viewed as associative rather than mechanistic. Further studies are required to determine whether these physiological differences translate into improved clinical recovery outcomes.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT07023107), registered on 8 June 2025.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity and age increase hypoxia risk during esophagogastroduodenoscopy under monitored anesthesia care: risk stratification and evaluation of a procedural oxygen mask.","authors":"Sam Bonge, Maaz Majid, James M Mirocha, Theodore Stein, Deena Midani, Derek Cheng, David Padua, Joshua Levy, Megumi Nakamura","doi":"10.1186/s12871-026-04122-1","DOIUrl":"10.1186/s12871-026-04122-1","url":null,"abstract":"<p><strong>Background: </strong>Deep sedation under monitored anesthesia care (MAC) during esophagogastroduodenoscopy (EGD) has a significant risk of hypoxia in obese patients. Recently high flow nasal cannula studies were conducted with good results for obese patients, however, data on Procedural Oxygen Mask (POM) are extremely scarce.</p><p><strong>Methods: </strong>The objectives of this study were to determine the incidence of hypoxia and impact of obesity during EGD, to describe our experience with POM, and to evaluate the risk factors and derive a prediction model using the machine-learning (ML) models. We reviewed the records of consecutive patients with BMI below 50 kg/m² who underwent EGD alone or both EGD and colonoscopy at our outpatient endoscopy center under MAC from 7/31/2023 to 1/31/2024. Multivariable logistic regression models were used to assess factors associated with hypoxia. In addition, we used our previously reported case series (n = 559) (Supplementary Table 1) and current data (n = 1294 without POM) to analyze the risk factors for hypoxia using machine-learning (ML) techniques.</p><p><strong>Results: </strong>The median age of the cohort was 58 years (range: 19-90). The median Body Mass Index (BMI) was 25 kg/m² (range: 15-45 kg/m²) with 302 obese (BMI > = 30 kg/m²). Intra-procedural hypoxia developed in 205 cases (15.4%). The incidence of hypoxia was significantly greater among those with obesity (84 of 302, 27.8%) compared to those without obesity (121 of 1021, 11.8%, p < 0.0001) with a difference of 16.0% (95% confidence interval [CI] 10.5-21.4%). No hypoxia was observed in the 29 POM-managed patients of whom 20 were obese. In multivariable analysis, obesity and age were associated with hypoxia (odds ratio [OR] 2.78, 95% CI 2.01-3.85, p < 0.0001, and OR 1.02, 95% CI 1.01-1.03, p = 0.001, respectively). Seven ML-based models were constructed which demonstrated modest area under the receiver operating characteristic curve of 60-65% in predicting hypoxia.</p><p><strong>Conclusion: </strong>Our study found that obesity and age are risk factors for hypoxia during EGD while the performance of ML-based models was modest. The current exploratory data of POM warrant further evaluation in the high-risk population.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring of breathing effort through pressure time product measurement using airway occlusion pressure (PTP_POCC study).","authors":"Emiliano Gogniat, Emilio Steinberg, Gustavo A Plotnikow, Sebastián Fredes, Roque S Moracci, Norberto Tiribelli, Javier H Dorado, Sergio Giannasi, Mariano Setten, José Dianti, Matías Madorno, Pablo O Rodriguez","doi":"10.1186/s12871-026-04113-2","DOIUrl":"10.1186/s12871-026-04113-2","url":null,"abstract":"<p><strong>Background: </strong>Monitoring respiratory effort is crucial to prevent ventilator-induced lung injury and diaphragmatic dysfunction, but esophageal manometry (the gold standard) is invasive an can be cumbersome. The airway occlusion pressure (ΔP_OCC) correlates with inspiratory effort but does not account for inspiratory time (Ti) or respiratory rate (RR). We aimed to validate a novel non-invasive index (PTP_POCC) that combines ΔP_OCC, Ti, and RR to estimate the esophageal pressure-time product (PTP_ESO).</p><p><strong>Methods: </strong>We conducted a prospective, multicenter, physiological, crossover study. Three levels of inspiratory pressure (5, 10, and 15 cm H₂O) were randomly applied in patients with invasive mechanical ventilation in pressure support mode. We simultaneously measured PTP_ESO and calculated the non-invasive PTP_POCC (PTP_POCC-min = (0.75 × ΔP_OCC × Ti / 2) × RR). Association was assessed using linear mixed-effects models. Diagnostic accuracy for detecting high (PTP_ESO >150 cmH₂O·s·min⁻¹) and low (PTP_ESO <50 cmH₂O·s·min⁻¹) inspiratory effort was evaluated using ROC curves.</p><p><strong>Results: </strong>A total of 49 patients were analyzed. A significant positive association was found between PTP_ESO-min and PTP_POCC-min (regression coefficient: 0.98; 95% CI: 0.86-1.1 p-value < 0.001). The mixed-effects model demonstrated good overall predictive performance (conditional R² = 0.80), although substantial inter-individual variability was observed (marginal R² = 0.40). The AUC for detecting high or low inspiratory effort was 0.91 (95% CI: 0.87-0.94), and 0.91 (95% CI: 0.88-0.94) respectively. Agreement analysis revealed proportional bias with wide limits of agreement.</p><p><strong>Conclusions: </strong>The PTP_POCC index showed good performance for identifying extremes of respiratory effort in mechanically ventilated patients. Despite limited individual agreement, its strong association and high specificity may make it a useful tool for confirming very low or excessively high inspiratory effort and for identifying patients at risk of over or under assistance.</p><p><strong>Trial registration: </strong>The study was registered on ClinicalTrials.gov under the identifier NCT06040138 ( https://clinicaltrials.gov/study/NCT06040138 ), first submitted date 2023-09-05.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}